Ep. 119: Kermit the Frog Leadership

Ceci Connolly: Welcome to her story, everyone. I am just so excited to bring to you today a very special guest, Dr. Meena Seshamani. She is a physician and a PhD Health economist, by the way. She is currently leading Medicare for the federal government. Her exact title is Deputy Administrator and Director of the Centers for Medicare and Medicaid Services that are known here in Washington as CMS. It is an enormous portfolio for the federal government, and we are so pleased to have you joining with us today. Meena, welcome.

Meena Seshamani: Thank you so much for having me, Ceci.

Ceci Connolly: Meena, I wanna talk a little bit before we get to your current very large job. I wanna share with the her story audience a little bit of how you got here. I. And so tell us first of all physician and economist talk about double barreled. What were you thinking back when you were a youngster about what you thought you might be when you grow up?

Meena Seshamani: I think given how long, I was in school, my parents were probably thinking, what were you thinking as well? It’s funny Ceci, because I do get asked this a lot by who are in various stages of their medical training, were interested in health policy and they say, tell me what the path was. What did you do? How did you plan this out? And I always tell them, you may be disappointed to hear that there really was no set path. I think ultimately, I. Found things that I enjoyed, that I felt I could utilize to contribute to, the community and the world around me. And that’s what has guided me through my own journey. I started off, I thought that I might wanna be a thought bio major in college, and I took a econ 1 0 1 class my second semester freshman year. Completely fell in love with economics and thought, okay, maybe instead of majoring in biology, I’ll major in economics. I was interested in going to, going into medicine. I had done volunteer work. I really enjoyed interacting with people in that way. I got this bug with economics and I said, okay, maybe I’ll pursue that a little bit further. And I ended up specializing in health economics. I came back to do my medical training because again, I really enjoyed that way of interacting with people and helping them and supporting them. I thought, okay, great. I’m gonna become a doctor in internal medicine and I planned my rotations in medical school. ’cause they tell you that if you’re interested in internal medicine, you should do your surgery rotation first. So you get like all the kinks out of the system so then you really, shine on your internal medicine rotation. I did my surgery rotation and I absolutely loved it. I thought, okay, and so really it has been through this journey just figuring out what inspires me, how I can best serve. And I ended up, specializing in head and neck surgery, otolaryngology. I have my PhD in health economics, and I’ve had the good fortune of being able. bring both of those experiences and expertise to bear in the work that I have done. Both leading in a large health system, driving, transforming of care, and also in various policy roles in the federal government from leading the Office of Health Reform in the Obama administration to lead implementation of the Affordable Care Act, and now leading the Center for Medicare and. Driving change for a program that serves more than 64 million people.

Ceci Connolly: So let’s talk a little bit about the fact that you have had some. Incredible success and experience in the private sector, and you’ve also done these in important stints in the federal government, and that’s a little bit of an unusual combination. So share with our listeners, many of whom are rising executives themselves and they’re thinking about their own trajectory. Share a little bit of your perspective in terms of what the private sector experience for you and your growth as you will, and then also compare it a little bit with public sector work.

Meena Seshamani: I will say it’s been very helpful for me. have experience in both the private and public sector, and especially being in healthcare, it’s been very important for me to have very recently taken care of patients at the bedside because I think that gives you an appreciation for the complexity of our healthcare system. We are all interrelated and we cannot solve the extremely complex issues that exist in our healthcare system if we are not all thinking about it together and working on it together. And the clinical practice that I’ve had really has driven home for me, just the humanity in all of it. Every time we work on a policy, I think of specific patients that I have had. And for example, now implementing the new drug law, I. remember one woman who I took care of who was on Medicare, who couldn’t afford the prescriptions that I was prescribing for her. And we got on our smartphones and we’re looking up good, a good RX to see what medications I could prescribe for her that she could afford. And so I think having perspective, having that appreciation for the depth of impact that what we do has and having a humility for the nuance and the complexity that it entails. Has been so important for me in my career journey to make sure that I am really bringing everything I can to the table so that we can really drive impactful change for so many people.

Ceci Connolly: It is striking to me when I look at the H S leadership, the C M S leadership, it’s striking how many women and people of color that I see around that table and in my 30 plus years. Washington pretty unusual. I’m curious if that’s a treat for you. But before we get to that, I am certain Alice, a woman of color rising up through a very competitive industry. You’ve encountered obstacles and barriers, and maybe you can share a little bit of that with our audience.

Meena Seshamani: Absolutely. I’m a woman of color. I also am a surgeon. Going through surgical training at that time women were definitely in the minority, in terms of obstacles. And I think. Many that I have experienced are likely ones that you’ve heard from other women as well, who you brought on the show. One thing is that sometimes my appearance seems to matter more than my qualifications. The number of times as a doctor entering a patient room, I would get comments about my appearance asking, are you old enough to be my doctor? One time I was being interviewed and I was asked about my appearance rather than my qualification. I think that is a common theme. Also,

Ceci Connolly: What do you say?

Meena Seshamani: Huh?

Ceci Connolly: When they asked about your appearance? How did you respond?

Meena Seshamani: I try to pivot it back to what my qualifications are. So if I have a patient who’s saying are you old enough to be my doctor? I say, in fact, I have two doctorates and I’m very happy that I get the chance to use them to take care of you today. And just trying to bring that back and, it’s definitely hard to sometimes be the only person in the room who. Who looks like you. There’s pressure with that, right? Where you feel you really have to perform. You have to show that we can do it too. And, you have to constantly, be striving that way. However, I also think it’s an incredible opportunity where I hope, especially through my journey and by what I can bring to the table, that I’m able to demonstrate that the perspectives that we all bring in, the ways that we have dealt with life. Being different. This is all part of the power that we bring to the table, and for me, it’s not just as a woman of color, it’s also as a single parent, as a daughter of immigrants, as a woman who’s a surgeon and an economist. I think all of these lend, this fuller perspective and way of approaching relationships. People, issues. That. I think all of us have those unique qualities that it benefits all of us if everyone is allowed to share those and bring those to the table as we are working on some very complex and important issues.

Ceci Connolly: So you’ve been in the current role leading all of Medicare for a few years now. What are some of the specific lessons in this high profile role? By the way?

Meena Seshamani: Sure. So I will start. The first thing that struck me almost right away was the incredible talent of the staff in the Center for Medicare. I. The level of institutional knowledge, how mission driven they are. It was really driven home to me the very first day the very first day of my job, I did new employee orientation. day of my job, I, this was in 2021, so everything was still on Zoom. So I did a webinar with webinar, nearly 800 career staff to introduce myself to them know, hi, I’m here, to lead the center. So when I met with them, I, told them a little bit about my background. I thanked them for all the work that they had done because I was leading the COVID response on the leadership team of a major health system. And every time they put out a policy, a waiver, it was incredible, the partnership so that we could all adjust to what we needed to do to address this incredibly fast moving and dynamic pandemic. Then I talked with the team about what it was that excited me to come and work with them. Talking about being able to address health equity issues that really were brought to the forefront during the pandemic. How can we really drive innovation so that we can, improve quality and really make care more whole person rather than siloed? And how can we be good stewards of the program to really promote affordability and sustainability of the program? And a few weeks later, without my asking, saying anything, each of my deputies gave me a Word document that was a table that had these three columns. Health, equity, quality, and innovation, stewardship of the program populated in this table. Were all of the ideas from the staff. Of things they had been thinking about, ideas they had, things they had seen when people come up and come in and talk to them of things that we could do. And that formed the basis of our strategic plan for the center. And it really has been an incredible journey with some pretty amazing people to really drive this kind of change. I think another one is just the reach of the Medicare program. So when we talk about all of these ideas, is not lost on me that we are the largest payer in our country. A trillion dollars in claims partnering with a million clinicians, 6,000 hospitals. So where you make a change in the Medicare program, it has ripple effects through the entire. System. When we think about what it means to have high quality care, when we think about how we need to have team-based approaches to care and think about the experiences in someone’s community that influences their health. When we make changes in policy in Medicare, everybody else is watching and everybody else is looking to it. And that’s a huge opportunity and a huge responsibility. And I think that ties into, maybe a third area of. means that we can’t do this work alone. It comes back to when you were saying what has been the experience being both in the private sector, practicing medicine, working in government.

It really has made me realize that no one can solve any of these issues alone. And how important it is that we are constantly engaging. I want to hear from that clinician on the ground taking care of a patient, what’s working and what isn’t. then when we do implement a policy, Really being able to engage to make sure that it’s coming to life on the ground. Like thanks to the new drug law people can get in Medicare, don’t have to pay anything for a vaccine, if you have a 72 year old grandmother who doesn’t know that has happened, she’s not gonna know to go and get that shambles vaccine that before, could have cost $200. So it’s so important that we are engaging in all steps of the process so that we can really make sure that these changes. Come to life on the ground to benefit the people that we’re serving.

Ceci Connolly: I’m reflecting just a little bit on that story of your, day two. It’s still the pandemic. Everything is by Zoom 800 people on Zoom. I. There are a lot of really interesting kind of leadership elements to that one scene and your decision to do that Zoom and have everyone on it and moving into a very large. Role of responsibility during a pandemic when you’re not getting the chance to interact with people. Can you reflect a little bit on that, the challenges of it, how you’ve tried to overcome them, especially in such a large organization?

Meena Seshamani: Yeah, definitely. I think some of it is just being genuine and real with people. Even on Zoom, zoom is two dimensional and it can be hard. To make that personal connection. We tried to put things into place to, to foster those relationships even when we were virtual. So we do regular all staff meetings where we go through and celebrate all of the work that everyone is doing. I also do things called Meals with Meena, where we get a smaller group together to have lunch. Periodically and it’s, that’s been really incredible ’cause it’s a smaller group, like maybe 15 people. And when you have such a large organization, a lot of times people haven’t worked with each other or they’ve worked with each other, but they only know their name through an email or a document that they were editing together. And so the relationships that have been forged in those smaller settings has really been incredible as well. And again, I really think that it is about, Being authentic and enabling people to feel like they’re appreciated as human beings. That we all have other things in our lives that are important to us. One of our all staff meetings, I think it was like the second or third all staff meeting that we were having were allowed to, ask whatever question after we did the presentation and people started asking. me, they were like, can you tell us a little bit more about yourself? Or, do you have a family? How long have you lived in dc? What kinds of things do you like to do, outside of work? I answered these questions and I answered them honestly. And in fact that was one of the first times that I’ve ever spoken publicly, ’cause it’s in front of 800 people. being a single parent. I shared, that I’m a single parent. I grew up in New Jersey and I’ve got two kids, I’m a sports mom who’s traveling to God knows where for God knows what game. And after that all staff meeting, I got several emails women who work in the center. Saying how much they appreciated that. I was willing to share that when here I was, the director, right? It’s, Ooh, this is the political appointee, and I was griping about how I have to drive to the middle of nowhere New Jersey to go to an ice hockey rink at 6:00 AM One woman in particular actually sent me an email and she said, as a fellow brown girl from New Jersey who’s a single parent of two kids, I wanna thank you for inspiring me and reminding me that I can do it too. And when you think one person then does all of this amazing work to have all of this impact, there’s no way that you as a single person could do all the things you would wanna do, right? It’s all about linking arms. With your team and empowering and enabling all of them to achieve whatever it is they want to un unleash their creativity and, really drive the kind of change that most of us go into healthcare for.

Ceci Connolly: We like to ask here at her. Story about something that I refer to as your superpower. And sometimes I talk about how mine used to be sleep and now I’m casting around for a new one, but because that’s not going so great. But it’s really what maybe gives you that inch once in a while or the thing that, you can fall back on when there’s a challenge and it’s gonna help you get through. Have you got a superpower?

Meena Seshamani: My children would say managing logistics,

Ceci Connolly: It’s all that driving.

Meena Seshamani: all the moving pieces of running a household. But actually, just this past weekend someone who works with me in the sent me a note. They had found this like saying I think on the web somewhere and the saying said something like, be a Kermit the Frog. You’re wondering where is this going? But it said, be a Kermit the Frog. a creative vision and no ego. the unique talents of those around you. chaos. Show kindness. Be sincere. And this person sent me like this graphic thing, followed by a note that said, this is you are Kermit, which meant a lot to me. I think it comes back Ceci to some of what we’ve been talking about that I. I think I can, I really see the humanity all that we do work-wise, in healthcare. And I also see the humanity in all of the people who I work with. People generally go into healthcare because they really want to help people, they wanna change things. It’s intellectually challenging, it’s personally fulfilling and being able to tap into that, with a team to see together. What’s our true north? What’s our purpose? And to let that guide us in what we do to let that enable us to, overcome difficult days to face, really challenging timelines with, a new law you have to implement or to, face really challenging problems where it isn’t necessarily a straightforward answer. I think that’s something that I’ve really enjoyed being able to further develop. In my role leading Medicare and really instilling that, remembering that everyone is a full person with a full story that they bring to work. That you can be a human being. You can use humor to cut tension in a meeting and remind all of us that we’re in this together. So that wouldn’t my answer.

Ceci Connolly: I like it. Kermit I’m envisioning some green items coming.

Meena Seshamani: can sing the Rainbow Connection.

Ceci Connolly: this. Yes, exactly. It gets at another really important theme of her story, which is mentorship. And we would love to have, I. Some insight into mentors perhaps earlier in your career. Were there some, what were their particular skills and ways that maybe they brought you along or didn’t? And then how do you think about possibly being a mentor or encouraging others to be mentors?

Meena Seshamani: Absolutely. I think is probably stating the obvious, that mentors really are important and for me, I think what has been the most important aspect of those who I have had the privilege of calling my mentors is that they have all taken a very personal interest in me as a human being and my whole life. From, when I’m doing my medical training and then, something happens in my personal life and being able to say, okay, like, how can I make sure that I am able to, navigate that and make sure that I am continuing to bring all of the skills that I have to bear to the work I’m doing to, for example, I mentioned how I thought I was gonna be in internal medicine, and then all of a sudden I really liked surgery. My mentor was in internal medicine and he said, it’s amazing that you have found something that you love. So go and do it, and you will figure out a way forward because that’s the way you are. And just to have that encouragement and that validation and that support, I think has been really key. And so moving forward, you know where I am, being a mentor for others, particularly for women. I, I hope that I can show both through my actions and convey through my words, there is a place for women to lead in healthcare in, society in general. And it doesn’t have to be the way of a male c e o from the 1990s. There is a place for warmth, for humanity, for humor, for empowering others and to really create a safe space where, People can bring their fullest selves, both in conversations with me and to the work that they do, and that they can see the power in that and how that is really what drives ultimately that tipping point of change where people say, oh my gosh, this is amazing. It is amazing to be part of this journey. I’m having fun with the work I’m doing. I would say that’s what I really valued about the mentors I have and what, I hopefully bring to the mentoring relationships that I’m in.

Ceci Connolly: I am mindful of the fact that July 30 is a Medicare anniversary, I believe 58 years. That program much has happened over those many decades, and that program has evolved a long way. There are many wonderful aspects to it, but I think there’s often the conversation in Washington and outside beyond the beltway of what’s a vision for the future? How can it possibly be more equitable, more affordable, higher quality? Tell us a little bit about your vision for Medicare, especially for future generations. When we see so much change in healthcare.

Meena Seshamani: It’s a great question. And this comes back to when I was describing to you that first meeting that I had with The staff in the center for Medicare, where we are really driving our true north around advancing health equity, where we define health equity to be everyone having a fair and just opportunity to attain their optimal health, we’re looking at how we can expand access to coverage and care. How can we drive innovation for high quality whole person care, and how can we promote affordability and sustainability and smart spending of the Medicare dollar. With that vision, importantly, that is embedded in everything that we do. So to take the example of health equity, it’s not just about, oh, let’s have some project off on the side and that is gonna be our equity project. Because when you are running basically an an insurance company, what’s the experience of people who call into your call center? the experience of people who have to navigate between multiple doctors? We do oversight and auditing. And, the team brought forward, an oversight issue and we were talking about it. And we always ask ourselves with everything we do, what is the equity impact? And they said this is just our normal oversight. And I said the person who was affected because the care fell through the cracks. Were they native English speaker? No, they only spoke Spanish. they have family support? No, they didn’t because honestly, When there are cracks in the system, it’s those who have complex social needs, multiple chronic conditions, they’re the ones who fall through the cracks. So we really have to think about equity in absolutely everything that we do, everyday operations to more specific policies. And we take that same approach when we’re thinking about quality and we’re thinking about are we driving improvements in access? And we’re thinking about how you take that Medicare dollar and spend it in a way that cares for people. than just treat an individual disease. Because if all you’re doing is playing whack-a-mole in a 15 minute, siloed, segmented office visit, you’re not addressing the myriad of experiences that impact someone’s health. And that’s really a vision that we are trying to drive.

Ceci Connolly: Would you describe yourself as an intentional or an accidental leader?

Meena Seshamani: that’s a really good question. I think I would describe myself as a combination of both. And the reason I say that is because, again, coming back to where we started ce, I was the only person going into a surgical field with this interest in health policy. In fact, I remember sitting in the office of a chair of an otolaryngology department doing my residency interview where. He said to me, prove to me that the work that you do is important because it was very much a basic science, kind of mentality. Now, again, not many women in surgical fields, being a minority, and so in some ways I didn’t necessarily go into all of this thinking, oh yeah, that’s where I’m gonna be, because I didn’t necessarily see other people ahead of me to know what was possible. Again, just by rolling up my sleeves and having some good fortune and good luck, being able to seize on opportunities. I’ve had this incredible experience and opportunity to bring, my expertise and experiences to bear, and I think that’s where I have been very intentional, particularly where I have, I think to myself, what are the things that I wish I had? Going through this journey and really trying to make sure that I make that available for others. So really driving a culture of being accessible and approachable, being creative, valuing what everybody brings to the table, encouraging open dialogue. I think that’s something that’s very important and that I think has led to, to better work, and similarly the leader to say, Hey, I have your back. I will block and tackle, I will help to prioritize because I know that we can’t do everything. And I will be happy to be the one to say, this is very important, but we just can’t do that right now for, this, that, and the other reason, and other things to say it’s really important that we do this and I will do everything in my power to make sure we can get this done. I think that’s where I would answer in both ways.

Ceci Connolly: Speaking of good fortune and good luck, it has been our good fortune to have you with us today, Dr. Meena Seshamani. Leads Medicare within the federal government at CMS. She is a physician. She is a PhD health economist. She is passionate about improving healthcare and elevating women and people of color, and we just wanna say from her story. Meena, thank you for your time today.

Meena Seshamani: Thank you again for having me.